Humphrey Visual Field Analyzer Research Articles

Mean rate of progression of visual fields in patients with primary open-angle glaucoma and ocular hypertension attending a tertiary care center in South India - A prospective cohort study using FORUM® Glaucoma Workplace software.

To find out the mean rate of progression (MROP) of visual fields (VF) in patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT) using FORUM® Glaucoma Workplace. Two hundred and one eyes of 105 patients were included in this prospective cohort study. Patients with POAG and OHT were recruited, and VF analysis with 24-2 and or 10-2 was done using SITA standard strategy in Zeiss Humphrey Visual Field Analyzer (HFA). All the previous VFs were identified from FORUM software, and the baseline indices were recorded from the first reliable VF analysis. The present VF analysis was compared to the previous one using FORUM software, and the rate of progression (ROP) in VF was obtained by Guided Progression Analysis. MROP of VF in the POAG group was - 0.085 dB/year, ranging from -2.8 to 2.8 dB/year with a standard deviation (SD) of 0.69. In the OHT group, the MROP of VF was -0.003 dB/year, ranging from - 0.8 to 0.5 dB/year with an SD of 0.27. The MROP of VF in medically treated eyes with POAG was -0.14 dB/year with an SD of 0.61 and in surgically treated eyes was -0.02 dB/year with an SD of 0.78. The overall baseline mean VF index (VFI) was 83.19% and the final mean VFI was 79.80%. There was a statistically significant decrease in the mean VFI value from baseline to the final visit (P-value 0.0005). The mean ROP of VF in the POAG group was -0.085 dB/year and in the OHT group was - 0.003 dB/year.

Kinetic Perimetry on Virtual Reality Headset.

We present a portable automatic kinetic perimeter based on a virtual reality (VR) headset device as an innovative and alternative solution for the screening of clinical visual fields. We compared the performances of our solution with a gold standard perimeter, validating the test on healthy subjects. The system is composed of an Oculus Quest 2 VR headset with a clicker for participant response feedback. An Android app was designed in Unity to generate moving stimuli along vectors, following a standard Goldmann kinetic perimetry approach. Sensitivity thresholds are obtained by moving centripetally three different targets (V/4e, IV/1e, III/1e) along 24 or 12 vectors from an area of non-seeing to an area of seeing and then transmitted wirelessly to a PC. A Python real-time algorithm processes the incoming kinetic results and displays the hill of vision in a two-dimensional map (isopter). We involved 21 subjects (5 males and 16 females, age range 22-73 years) for a total of 42 eyes tested with our proposed solution, and results were compared with a Humphrey visual field analyzer to test reproducibility and efficacy. isopters generated with the Oculus headset were in good agreement with those acquired with a commercial device (Pearson's correlation values r > 0.83 for each target). we demonstrate the feasibility of VR kinetic perimetry by comparing performances between our system and a clinically used perimeter in healthy subjects. proposed device leads the way for a portable and more accessible visual field test, overcoming challenges in current kinetic perimetry practices.

The Comparison of Foveal Sensitivity Between Diabetic and Non-diabetic Patients by Using Standard Automated Perimetry 10-2 Protocol: A Cross-Sectional Study.

Purpose The purpose of the study is to assess whether standard automated perimetry (SAP) was capable of detecting early neuroretinal changes by comparing foveal sensitivity in diabeticand non-diabetic subjects. Settings and design This is an observational and cross-sectional study that compared foveal sensitivity between a case group of 47 subjects with no or mild-to-moderate diabetic retinopathy (DR) without maculopathy and a control group of 43 healthy subjects. Materials and Methods After a thorough ocular examination, all patients were put through tests using a Humphrey visual field analyzerwith the Swedish interactive threshold algorithm (SITA) standard system (10-2 software). The primary indicator of success was the age-adjusted foveal awareness-esteem difference. Mean deviation (MD) and pattern standard deviation (PSD) readings were the supplementary performance indicators. Results The mean age of the case and control group was 50.76 ± 13.20 years and 49.90 ± 12.20 years, respectively. The probability of cataract development was higher in the case group (p< 0.0001). In the control group, 95.3% had best-corrected visual acuity (BCVA) in the category of good visual acuity (VA) (p < 0.0001). The mean foveal sensitivity in the case group was 28.57 ± 7.54 and 32.16 ± 7.09 for the control group, and the difference was statistically significant (p < 0.023). The mean of MD in the case group was -6.05 ± 7.93, whereas in the control group, it was -3.28 ± 1.70, which was found significant (p = 0.027). There was no difference in PSD between the study groups. Conclusions Foveal sensitivity decreased in diabetics, even without maculopathy, so SAP helps identify a patient at risk of future vision loss.

Correlation between visual field and retinal nerve fiber layer thickness in adult north Indian population from Gurugram region with glaucoma suspect

: To find the correlation between visual field and retinal nerve layer thickness in adult North Indian population from Gurugram region with glaucoma suspect. Correlative and quantitative study was carried between the visual field and retinal nerve fiber layer (RNFL) thickness of 400 adult eyes. The age of subjects participating in the study ranged between 18 to 80 years with mean age 45 ± 14years. The standard automated perimetry was acquired by Humphrey visual field analyser using 24-2 SITA standard strategy. Retinal nerve fiber layer thickness was measured by Spectral Domain OCT (3D OCT2000FA). Visual field was performed on the same day or within ± three months of OCT acquisition. Statistical analysis was performed using MS Excel, SPSS (ver.20) and other descriptive statistical tools.: The mean MD and PSD were -2.79 dB ±2.21 and 2.52 dB ±1.49, respectively. The average thickness of RNFL of the four quadrants calculated was 98.40 µm±10.70. RNFL thickness in an inferior and superior quadrant was 122.49µm ± 16.71 and 118.86 µm ±15.21 respectively. The mean cup to disc area ratio (CDAR) in the glaucoma suspect subject was 0.60± 0.10, and the vertical cup to disc ratio (VCDR) was 0.74± 0.074. Correlation of the average RNFL thickness, Inferior RNFL thickness and superior RNFL thickness with GHT was 0.245(P=0.011), 0.19 (P=0.094) and 0.27, (P=0.004), respectively. Superior RNFL thickness showed a more significant Correlation (r= 0.193, P&amp;#60;0.01) with mean deviation (MD) of the visual field. Retinal nerve fiber layer thickness demonstrated a weak to mild and statistically significant correlation with the visual field. The correlation of average RNFL thickness with Visual field global indices and parameters were significant but weaker. Correlation between superior RNFL thicknesses was highest with GHT in adult North India Gurugram subjects with glaucoma suspect. Superior RNFL thickness showed a higher Correlation with Mean deviation (MD) and VFI of the visual field

Clinical Spectrum of Indirect Traumatic Optic Neuropathy in South Indian Subjects Observational Study

Purpose: To report the aetiology, visual outcome, and clinical features of indirect traumatic Optic Neuropathy (TON) patients from the tertiary eye care center in South India. Methods: It is a retrospective and observational study. Details of age, gender, number of days of presentation after injury, Snellen visual acuity at presentation and last follow-up, visual evoked potentials, visual field findings using the Humphrey visual field analyser, associated ocular complications, and mode and time of treatment were obtained from the medical records of all indirect TON patients. Results: Indirect TON patients are mainly young males (94%) and road traffic accident (RTA) (65%) is the main cause of TON, followed by falls (19%) and sport-related activities (11%). Visual acuity loss was severe in more than 50% of the subjects and only 16%% of the patients showed improvement in visual acuity greater than one line. Pattern visual evoked potentials and visual fields are recordable only in 15% of the subjects. Commonly associated ocular complications in indirect TON patients were orbital fracture (43%), lid tear (16%), sub-conjunctival haemorrhage (13.5%), and angle recession (13.5%). Three out of four patients who received methylprednisolone and oral steroids within a week showed an improvement in visual acuity of greater than three lines, while just one patient out of four who received the same medication after a week improved visual acuity of three lines. Conclusion: RTA (road traffic accidents) is the most common cause of indirect TON and mainly young males were the affected individuals. IVMP along with oral steroids within a week, would help TON patients for reasonable visual recovery. Presenting Visual acuity of &gt; 6/600 and recordable pattern VEPs would be the prognostic factors for good visual outcomes in indirect TON patients.

Cataract versus combined surgery in pseudoexfoliation glaucoma.

Pseudoexfoliation glaucoma (XFG) is often associated with a higher rate of intraoperative complications and failure. This study aims to compare the long-term clinical and surgical outcomes of cataract surgery alone versus combined surgery in XFG. comparative case series. All patients with XFG who underwent either cataract surgery alone [group 1: either phacoemulsification, PHACO/small-incision cataract surgery (SICS), n = 35] or combined surgery (group 2: phacotrabeculectomy, PHACOT or SICS + trabeculectomy, n = 46) from 2013 to 2018 by a single trained surgeon were screened and recalled for a detailed clinical examination, including Humphrey visual field analysis at 3-monthly intervals for a minimum of 3 years. Surgical success (intraocular pressure, IOP, <21 mm Hg and >6 mm Hg with (qualified success) or without medicines, complete success, survival rates, visual field changes, and need for additional procedures/medicines for IOP control were compared between groups. A total of 81 eyes of 68 patients with XFG were included in this study (groups 1-35 eyes and groups 2-46 eyes each). Both groups achieved 27-40% IOP reduction from preoperative IOP levels, P < 0.001. Surgical success rates were similar in both groups (complete success 66% vs 55%, P = 0.4), qualified success 17% vs 24%, P = 0.8, in groups 1 and 2). Kaplan-Meier analysis showed a marginally better survival rate for group 1, 75% (55-87%), than group 2, 66% (50-78%), at 3 and 5 years which was not significantly different. The number of eyes that progressed at 5 years after surgery (5-6%) was similar in both groups. Cataract surgery can be as effective as combined surgery in XFG eyes with regards to final visual acuity, long-term IOP profile, and visual field progression, and complications/survival rates are comparable between the two procedures.

A Novel Visual Field Screening Program for Glaucoma With a Head-Mounted Perimeter.

A novel visual field screening program with a head-mounted perimeter 'imo' could detect glaucoma at all stages in a short time with high accuracy. The present study aimed to examine the accuracy and availability of a novel glaucoma visual field screening program using a head-mounted visual perimeter 'imo.' Eyes of 76 non-glaucoma participants and 92 glaucoma patients were examined. All patients underwent visual field tests using the Humphrey Visual Field Analyzer (30-2 or 24-2 Swedish Interactive Thresholding Algorithm standard program) and imo (the visual field screening program). We evaluated five visual field screening program indicators: sensitivity, specificity, positive predictive value, negative predictive value, and testing time. We also evaluated the ability of this visual field screening program to differentiate between glaucoma patients and normal controls using the receiver operating characteristic curves and areas under the receiver operating characteristic curves. The sensitivity, specificity, positive predictive value, and negative predictive value of the visual field screening program were 76%-100%, 91%-100%, 86%-89%, and 79%-100%, respectively. The visual field screening program test time was 46±13 seconds for normal controls and 61±18, 82±21, and 105±16 econds, respectively for mild, moderate, and advanced-stage patients. The areas under the receiver operating characteristic curves were 0.77, 0.97, and 1.0 in the mild, moderate, and advanced stages, respectively. Visual field screening using a head-mounted perimeter 'imo' detected glaucoma at all stages in a short time with high accuracy.

Use of multifocal electroretinograms to determine stage of glaucoma.

To determine whether multifocal electroretinograms (mfERGs) recorded with natural pupils and skin electrodes can be used to determine the stage of open angle glaucoma (OAG). Two hundred eighteen eyes of 132 OAG patients and 62 eyes of 62 normal subjects whose best-corrected visual acuity (BCVA) was 0.1 logarithm of the minimum angle of resolution (logMAR) units (20/25) or less were studied. The mean deviations (MDs) obtained by Humphrey Visual Field Analyzer (HFA), optical coherence tomographic (OCT) images, and mfERGs were analyzed. The glaucoma was classified into 4 stages: preperimetric glaucoma (PPG), early stage, moderate stage, and advanced stage glaucoma. The parameters of the mfERGs examined were the amplitudes of the two positive peaks (P1, P2) of the second order kernels in the nasal and temporal fields within the central 15° diameter. The mean age of all participants (patients and normals) was 63.8 ± 10.8 years. With the progression of glaucoma, the amplitudes of P1 in the nasal hemifield increased and the amplitudes of P2 decreased. The nasal to temporal ratio (N/T ratio) of the P1 amplitudes and the negative slope of the line between P1 and P2 (P1P2 Slope) in the nasal field were larger at each glaucoma stage except at the PPG stage. Both the N/T amplitude ratio and P1P2 Slope were weakly but significantly correlated with the MD (r = -0.3139, P<0.0001; r = 0.4501, P<0.0001, respectively), and the OCT parameters (all P<0.0001) except the outer layer thickness. Our findings indicate that the amplitudes of P1 and P2 of the second order kernel of the mfERGs in the nasal field of the center region can be good markers for the stages of glaucoma.

Usefulness of critical flicker fusion frequency measurement and its laterality for evaluating compressive optic neuropathy due to pituitary neuroendocrine tumors.

Critical flicker fusion frequency (CFF) is a short but sensitive method for evaluating optic nerve function. We measured CFF in patients with pituitary neuroendocrine tumors (Pit-NETs) to assess its usefulness. Data from 184 patients with nonfunctioning Pit-NETs, who had been treated with transsphenoidal surgery and had no medical history of eye diseases, was used in this retrospective study. Visual acuity decline (VAD) was defined as > 0.10 reduction in logMAR visual acuity and CFF decline (CFD) was defined as CFF value < 35Hz. Visual field defect (VFD) was evaluated by automated perimetry on a Humphrey visual field analyzer. Potential associations between abnormal test results and tumor height from the suprasellar were analyzed. Contact between the optic nerve or chiasma and the tumor was present and absent in 161 and 23 patients, respectively. In patients showing contact, the difference in CFF between the left and right eyes was larger (p = 0.0008), and the optimal cutoff value using the receiver operating characteristic curve was 3Hz. Therefore, ≥ 3Hz was considered positive for CFF laterality (CFL), the most prevalent condition. Tumor height was lower in patients with CFL positivity compared to those with VAD or VFD (p < 0.01). The prevalence of test abnormalities was the highest for small tumors compared to those of other tests. Changes in CFL permit early detection of Pit-NETs. Our results indicate that CFF laterality can be seen in the early stages of compressive optic neuropathy due to Pit-NET.

EE71 Cost-Effectiveness of Screening for Hydroxychloroquine Retinopathy

Hydroxychloroquine (HCQ) can induce retinopathy, which may result in vision loss. Therefore, it is recommended that patients on long-term HCQ treatment are screened annually using Spectral Domain- Optical Coherence Tomography (SD-OCT) and Humphrey visual field analyzer (HFV). Although screening is effective, it is also costly and the risk for HCQ retinopathy differs between patients. Therefore, this study analyses the cost-effectiveness of screening for HCQ retinopathy.

Papillary and Peripapillary Hemorrhages in Eyes With Pathologic Myopia.

To determine the prevalence, characteristics, and causes of papillary and peripapillary hemorrhages (PPHs) in eyes with pathologic myopia (PM). PM patients were retrospectively studied between 2011 and 2018. Fundus images were used to diagnose and classify the PPHs. Fundus fluorescein angiographic (FFA) and optical coherence tomographic (OCT) images were used to determine the status of the retinal vessels and tissue at and around the PPH sites. Visual field data determined by Goldmann perimetry and Humphrey visual field analyzer were also analyzed. A total of 2171 PM patients (3774 eyes) were examined. Eighty-eight patients (97 eyes) had PPHs (mean age 66.8 ± 11.9 years; mean axial length 30.79 ± 2.17 mm) for a prevalence of 4.05%. Thirty (30.9%) eyes recurred. Among the 90 eyes with a single-site PPH, the most common type and location were the conus type (49 eyes, 54.4%) and the temporal side (66 eyes, 73.3%), respectively. Regression analysis showed that patchy atrophy reduced the risk of recurrences than diffuse atrophy (P < 0.05), whereas a longer axial length and potential glaucoma increased the risk (both P < 0.05). FFA and OCT showed that PPHs developed in the area of straightened retinal arterioles (24 eyes), at or beside the peak of a ridge (10 eyes), in an area of compressed retinal tissue (two eyes). PPHs are present in 4.05% of PM eyes, and they are most often located in the temporal peripapillary atrophic region of the retina. Axial elongation, mild myopic maculopathy, and potential glaucoma are risk factors for recurrences.

Virtual Reality Hemifield Measurements for Corrective Surgery Eligibility in Ptosis Patients: A Pilot Clinical Trial

PurposeWe developed an accelerated virtual reality (VR) suprathreshold hemifield perimetry algorithm, the median cut hemifield test (MCHT). This study examines the ability of the MCHT to determine ptosis severity and its reversibility with an artificial improvement by eyelid taping on an HTC Vive Pro Eye VR headset and the Humphrey visual field analyzer (HVFA) to assess the capabilities of emerging technologies in evaluating ptosis.MethodsIn a single visit, the MCHT was administered along with the HVFA 30-2 on ptotic untaped and taped eyelids in a randomized order. The primary end points were a superior field visibility comparison with severity of VF loss and VF improvement after taping for MCHT and HVFA. Secondary end points included evaluating patients’ Likert-scaled survey responses on the comfort, speed, and overall experience with both testing modalities.ResultsVR's MCHT superior field degrees visible correlated well for severe category margin to reflex distance (r = 0.78) compared with HVFA's (r = −0.21). The MCHT also demonstrated noninferiority (83.3% agreement; P = 1) against HVFA for detection of 30% or more superior visual field improvement after taping, warranting a corrective surgical intervention. In comparing hemi-VF in untaped eyes, both tests demonstrated relative obstruction to the field when comparing normal controls to severe ptosis (HVFA P < 0.05; MCHT P < 0.001), which proved sufficient to demonstrate percent improvement with taping. The secondary end point of patient satisfaction favored VR vision testing presentation mode in terms of comfort (P < 0.01), speed (P < 0.001), and overall experience (P < 0.01).ConclusionsThis pilot trial supports the use of MCHT for the quantitative measurement of visual field loss owing to ptosis and the reversibility of ptosis that is tested when conducting a presurgical evaluation. We believe the adoption of MCHT testing in oculoplastic clinics could decrease patient burden and accelerate time to corrective treatment.Translational RelevanceIn this study, we look at vision field outputs in patients with ptosis to evaluate its severity and improvement with eyelid taping on a low-profile VR-based technology and compare it with HVFA. Our results demonstrate that alternative, portable technologies such as VR can be used to grade the degree of ptosis and determine whether ptosis surgery could provide a significant superior visual field improvement of 30% or more, all while ensuring a more comfortable experience and faster testing time.

Evaluation of visual field changes with retinal nerve fiber layer thickness in primary congenital glaucoma.

To evaluate visual field changes in primary congenital glaucoma (PCG) with retinal nerve fiber layer thickness on optical coherence tomography. In this cross-sectional, observational study, consecutive PCG children who underwent combined trabeculotomy with trabeculectomy and on regular follow-up were enrolled. All patients were aged over four years and co-operative for RNFL OCT and visual field examination. Perimetry was done on Humphrey visual field (HVF) analyzer using 30-2 and 10-2 SITA standard algorithms as appropriate. If a reliable automated perimetry was not feasible, kinetic perimetry was done. The following were noted at baseline and every follow-up: age, sex, visual acuity, intraocular pressure (IOP), cup-disc ratio (CDR), corneal diameters, refraction, any topical antiglaucoma medications, surgeries underwent, age at surgery and duration between surgery and final examination. Forty-eight eyes of 34 children operated for PCG and 19 eyes of 17 controls were analyzed. A statistically significant thinner average RNFL thickness of 87.2 ± 28 μm was noted in PCG eyes as compared to controls with 100.6 ± 7.2 μm (P = 0.04). The mean cup-disc area ratio on OCT in PCG eyes was 0.43 ± 0.2 (0.02-0.93) and in control eyes was 0.23 ± 0.07 (0.1-0.4) (P < 0.001). On RNFL OCT, there was significant focal RNFL loss in temporal superior (P = 0.003), nasal inferior (P = 0.037) and temporal inferior (P < 0.001) quadrants compared to controls. Among PCG eyes, 20/48 eyes (41.7%), had definitive, reproducible glaucomatous VF defects. Mean baseline IOP in PCG eyes with VF defect was 28.7 ± 5.7 mmHg and in eyes with normal VF was 24.6 ± 5.9 mmHg (P = 0.03). On univariate regression analysis, higher baseline IOP was significantly associated with both RNFL loss (odds ratio (OR): -2.17) and VF defects (OR: 3.35). Fluctuation in follow-up IOP (OR: 3.33) was also significantly associated with the presence of VF defects. On multivariable regression analysis maximum, IOP was significantly associated with RNFL loss and VF defects. Peripapillary RNFL thickness could be used to identify PCG eyes having visual field loss and possibly poor visual function from PCG eyes without visual field defects. Baseline and follow-up IOP, significantly correlated with RNFL thickness in PCG eyes.

Study of anxiety in patients with glaucoma undergoing standard automated perimetry and optical coherence tomography - A prospective comparative study.

To compare the anxiety levels related to visual field testing and optical coherence tomography (OCT) in patients with glaucoma. This prospective, comparative study was conducted on patients with glaucoma. The participants' anxiety traits were assessed using the State-Trait Anxiety Inventory [STAI]. Before visual field testing on Humphrey visual field analyzer (HVF) and retinal nerve fiber analysis on OCT, the participants completed Form Y1 to measure the current pretest level or 'State' anxiety [pretest anxiety]. Immediately after testing, participants were administered the Form Y1 questionnaire to assess the induced anxiety level during the testing [Intratest anxiety]. A total of 228 patients were enrolled with 152 participants in the HVF group and 76 in the OCT group. The mean age of the participants in the HVF group was 57.2 ± 20.8 years and in the OCT group was 56.8 ± 20 years. There was no significant difference in trait and pretest anxiety between the HVF group and the OCT group (P = 0.971 and P = 0.716). Intratest test anxiety score was slightly higher in the HVF group (HVF: 42.13 ± 10.63, OCT: 40.71 ± 9.76; P = 0.33). The anxiety scores were higher when the experience of previous HVF tests was <2 and least when the number of tests exceeded five. Automated perimetry induces slightly more anxiety than OCT, which may affect test performance. The measured anxiety reduces as patients gain familiarity with the test with experience. This adds credence to the recommendation of more frequent visual field testing in newly diagnosed glaucoma patients.

Cardiac Hypertrophy May Be a Risk Factor for the Development and Severity of Glaucoma.

The purpose of this study was to examine the relationship between glaucoma and cardiac abnormalities. We evaluated 581 patients with open-angle glaucoma (285 men and 296 women) and 595 individuals without glaucoma (273 men and 322 women). All of the participants underwent visual field testing using a Humphrey Visual Field Analyzer (30-2 program), an electrocardiogram (ECG), and blood pressure measurement. We examined the ECG abnormalities and other factors (age, intraocular pressure (IOP) and systemic hypertension) involved in the development and severity of glaucoma. Logistic regression analyses revealed significant correlations of glaucoma with IOP (OR = 1.43; 95% CI: 1.36–1.51; p < 0.00001), atrial fibrillation (OR = 2.02; 95% CI: 1.01–4.04; p = 0.04), left ventricular hypertrophy (LVH) (OR = 2.21; 95% CI: 1.15–4.25; p = 0.02), and bradycardia (OR = 2.19; 95% CI: 1.25–4.70; p = 0.02). Regression analyses revealed significant correlations of the mean deviation of the visual field with age (t = –6.22; 95% CI: −0.15, −0.08; p < 0.00001), IOP (t = −6.47; 95% CI: −0.42, −0.23; p < 0.00001), and LVH (t = −2.15; 95% CI: −3.36, −0.29; p = 0.02). Atrial fibrillation, LVH and bradycardia may decrease the cerebral blood flow, and may also affect the ocular blood flow. Cardiac abnormalities may be associated with the development and severity of glaucoma.

Dopamine agonist for the rapid improvement of visual field defects in giant and macro-prolactinomas

To evaluate effect of first-line dopamine agonist (DA) therapy as an alternative to surgery for visual field defect (VFD) recovery in giant and macro-prolactinoma. In this retrospective study, 125 patients with giant and macro-prolactinoma, except those with a history of previous surgery or radiotherapy, were evaluated. Those who underwent visual field examinations using the Humphrey Visual Field analyser upon initial assessment and after treatment were included for analysis. Twelve patients with VFD were included. The effects of DA therapy on both VFD and tumor size were evaluated within the first three months. There were twelve patients analysed: three females and nine males, five giant and seven macroprolactinomas; eight patients received cabergoline (CAB) and four patients received bromocriptine (BRC). The mean adenoma diameter was 35±13mm (range 15-60), and the mean PRL level was 3,523ng/dL (range 312-11,703). Eight patients (67%) complained of blurred vision, while four patients (33%) reported no visual symptoms. After a median duration of three weeks, the VFD completely resolved in ten patients (83%) but only partially improved in two (17%). The mean initial doses of CAB and BRC that provided VFD improvement were 0.5±0.2mg/week and 6.3±1.4mg/day, respectively. After a mean duration of 2.2±0.9months, the mean decrease in adenoma size was 43.6±24.5% (range 10-95%). The use of DA as a first-line treatment for at least one month before deciding on surgery is recommended in giant and macro-prolactinomas with VFD. Surgery should be considered only in cases with DA resistance or persistent visual impairment despite medical therapy.

Patterns of Visual Field Loss in Early, Moderate, and Severe Stages of Open Angle Glaucoma.

Even in the early stages of glaucomatous visual field defects (VFDs), 49% of the defects occurred in both hemifields and 28% involved the central 5 degrees of the visual field (VF), which may have prognostic values. The aim was to determine the patterns of glaucomatous VFDs in early, moderate and severe stages of primary open angle glaucoma, using the Glaucoma Staging Application. According to the Modified University of Sao Paulo Glaucoma Visual Field Staging System Classification, patients with early, moderate and advanced VFDs were selected by the Glaucoma Staging Application using all databases of the Humphrey Visual Field Analyser of a glaucoma referral practice. We analyzed one VF of the 100 patients included in each group. The analysis consisted of classifying all exams regarding the location of the defects, the hemifields involved, and the connection to the blind spot. We analyzed 300 VF. In the Early group, 27% of the VFDs are connected to the physiological blind spot, 64% in the Moderate group, and 95% in the Severe group ( P <0.01). In the Early group, 28% of the defects involved the central 5 degrees of the fixation, 59% in the Moderate and 88% in the Severe group. In the Early group, 49% of the defects involved both hemifields, 80% in the Moderate and 80% in the Severe group. With increasing glaucoma severity, VFD showed a more central pattern, connected to the blind spot, and involved both hemifields. In early disease, both hemifields were commonly affected and more than a quarter of VFD involved the central 5 degrees close to fixation. Careful monitoring of the central VF in glaucoma is suggested.

GlauCUTU: Time Until Perceived Virtual Reality Perimetry With Humphrey Field Analyzer Prediction-Based Artificial Intelligence

The increasing prevalence of glaucomatous optic neuropathy, which can result in permanent blindness (visual impairment), accentuates the importance of screening and early diagnosis for prevention of blindness. GlauCUTU, a novel time until perceived (TUP) visual field (VF) testing, utilizes a portable virtual reality (VR) headset with visual stimulus that progressively increases in intensity to detect VF defects. GlauCUTU was evaluated on participants with normal visual fields and those with early, moderate, and severe glaucoma. Responses were collected in terms of time until response (TUR). TUR was used to calculate TUP and reported in terms of GlauCUTU sensitivity. False positives were detected with pretest and latency analysis using reaction time (RT). In addition, a novel automated transformation was developed to convert GlauCUTU sensitivity into HFA sensitivity using machine learning (ML) and deep learning (DL) algorithms. Visual field index (VFI) was generated from HFA sensitivity to determine severity of glaucoma. The VFI results were evaluated using post-hoc analysis from two-way analysis of variance (ANOVA). Results demonstrate no significant difference (p=0.073) between Humphrey visual field analyzer (HFA) and GlauCUTU with machine learning transformation (GlauCUTU-ML) in all glaucoma stages. However, there was a significant difference between HFA and GlauCUTU with deep learning transformation (GlauCUTU-DL) in severe glaucoma (p<0.050). GlauCUTU-ML generates the lowest root mean square error (RMSE) of 4.92. Meanwhile, GlauCUTU-DL yields the highest Pearson’s <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$r$ </tex-math></inline-formula> correlation coefficient with HFA of 0.74, but produces the highest RMSE of 6.31. Comparison between three expert ophthalmologists’ grading of glaucomatous eyes on GlauCUTU-ML and HFA aligns with the majority voting with an average agreement of 0.83, which is highly reliable. All in all, the portable and inexpensive GlauCUTU perimetry system introduces the use of TUP for VF evaluation with results comparable to HFA. GlauCUTU proves to be a promising method to increase accessibility to glaucoma screening, particularly in low-resource setting countries.

Does outer retinal layer thickness correlate with the central visual field indices in early dry age-related macular degeneration?

Age-related macular degeneration (ARMD) is the leading cause of irreversible blindness worldwide and Nepal is one among them. We aimed to determine the relationship between outer retinal layer thickness parameters with central visual field indices in early dry ARMD cases among Nepalese population. The subjects for this descriptive, cross-sectional study comprised 40 patients with early dry ARMD from the ophthalmology department of a tertiary level hospital of Nepal. The retinal layer thickness was measured with spectral-domain optical coherence tomography (SD-OCT), and the visual field indices were assessed using the 10-2 protocol of Humphrey visual field analyzer (HFA). Thus, the retinal layer structures correlated with visual field indices among our population. Among our early dry ARMD population, the foveal threshold (FT) was found to be significantly correlated with retinal pigment epithelium (RPE) elevation (P < 0.01, r = -0.541), outer segment (OS) length (P = 0.02, r = 0.465), and inner segment ellipsoid (ISe) band disruption (P = 0.01, r = -0.499), but not with presence of hyperreflective foci (P = 0.464), RPE thickness (P = 0.612), and central macular thickness (P = 0.214). However, no significant correlation between mean deviation and pattern standard deviation of visual field with retinal layer thickness parameters was identified. In early dry ARMD, a reduced FT is significantly correlated with the integrity of the ISe band, thinning of OS length, and drusen-associated RPE elevation. The results highlight the utility of both SD-OCT retinal layer measurement and central visual field testing by HFA in ARMD to monitor the progression of the disease.

Ocular blood flow and choroidal thickness in ocular hypertension.

Ocular hypertension (OHT) is a clinical entity characterized by elevated intraocular pressure (IOP) without optic nerve damage. In the presence of other risk factors, OHT may progress to glaucoma. This study aimed to evaluate ocular blood flow (OBF) and choroidal thickness (CT), which may be markers and/or risk factors that could assess the progression of OHT to glaucoma. Age and gender matched 60 eyes of 32 patients with OHT and 61 eyes of 31 control patients were included for this study. All participants underwent a detailed ophthalmological examination including best-corrected visual acuity, IOP measurement with Goldmann applanation tonometry, gonioscopy, optic nerve evaluation with 78 D lens, and visual field test with Humphrey visual field analyzer. Retinal nerve fiber layer, ganglion cell complex, and central corneal thickness measurements were performed by optical coherence tomography (OCT). CT was measured with OCT in the fovea, 1.5mm, 2mm, 2.5mm nasal and temporal to the fovea and from nasal and temporal to the optic disk. OBF data including peak systolic velocity (PSV), end-diastolic velocity (EDV), resistivity index (RI) and pulsatility index (PI) were measured with color Doppler imaging (CDI) from the ophthalmic artery (OA), central retinal artery (CRA), medial and lateral branches of short posterior ciliary arteries (MPCA, LPCA). Systolic (SBP) and diastolic arterial blood pressure were also noted. CT measurement at each point in the OHT group compared to the control group were found to be significantly thinner (p = 0.001). There was a decrement in CT from the fovea to the nasal and temporal retina in both groups. In the OHT group, there was a significant decrease in PSV and EDV of OA, CRA, MPCA, and LPCA, and a significant increase in PI and RI of measured arteries. (EDV p = 0.036, PI p = 0.006, RI p = 0.006 for OA and p = 0.001 for other arteries and all OBF measurements). There was a negative correlation between CT and age, IOP and axial length (AL) in OHT group (r = - 0.529, p = 0.001; r = - 0.258, p = 0.047; r = - 0.345, p = 0.007, respectively, for fovea). But there was no statistically significant correlation between CT and other measurements in the control group, except age (r = - 0.860 p = 0.001 for fovea). We found that OBF decrement and choroidal thinning in OHT group compared with controls. Interpretation both of CT measurements with OCT and OBF parameters with CDI and new imaging technologies may help to prevent and reduce the possible optic nerve damage.